PROGNOSTIC IMPORTANCE OF MYOCARDIAL ISCHEMIA

冠状动脉疾病的许多破坏性临床特征可能是 没有症状或者毫无征兆地出现。活动性心肌缺血是 冠状动脉粥样硬化的一个重要功能表达和 是这些临床表现中的大多数的基础。目标是在医院进行测试 在风险评估中可以测量心肌缺血的活动性 但在日常生活中不要考虑缺血。心电图学 对看似稳定的非卧床患者的监测显示 无症状心肌缺血，许多新特征未见 在医院进行的测试中(例如，事件大多是无症状的， 令人惊讶的延长，与压力无关，并显示出昼夜节律 与报道的心肌梗死相似)。这项研究旨在 动态心肌梗死患者心肌缺血活动度的测定 冠状动脉疾病出院，以便：a)研究 自然缺血史与冠状动脉病变发生的关系 事件；b)检查所有出院的活动性缺血对 预后；以及c)确定对活动性缺血的监测是否提供 冠状动脉事件风险的增量信息[通常情况下 测试。一项针对连续患者的前瞻性研究将描述 根据病史、症状、危险因素、运动试验进行 心肌缺血和心导管术数据。连续48小时 频率调制的动态心电监测将 在基线和6个月时按和不按标准服药 间隔时间。所有活动性脑缺血的频率和持续时间 医院将在多变量分析中与症状、临床 和实验室数据，以及冠状动脉事件的发生，如 死亡、心肌梗死、不稳定型心绞痛住院和 需要血运重建。这项计划的长远目标是： A)测试所有出院缺血的重要性 稳定的冠心病患者作为未来风险的衡量标准 冠状动脉事件比常规检测更具区分性 医院，以及b)为评估效果提供客观手段 新的治疗方法。医院外的动态监测显示， 无症状性脑缺血是常见的，在治疗中被忽视。 冠心病患者的病情明显稳定。如果……的活动 缺血影响预后，可能不足以治疗症状 单独和新的目标可能是必要的，目的是控制所有活跃的 日常生活中的缺血。

Many of the damaging clinical feature of coronary artery disease can be asymptomatic or present without warning. Active myocardial ischemia is an important functional expression of coronary atherosclerosis and underlies most of these clinical manifestations. Tests in hospital aimed at the assessment of risk can measure the activity of myocardial ischemia but do not consider ischemia during daily life. Electrocardiographic monitoring in apparently stable ambulatory patients has shown frequent asymptomatic myocardial ischemia with many new characteristics not seen in tests performed in hospital (e.g., events are mostly asymptomatic, surprisingly prolonged, not related to stress and show a diurnal rhythm similar to that reported for myocardial infarction). This study aims to quantify the activity of myocardial ischemia in ambulatory patients with coronary artery disease out of the hospital in order to: a) study the natural history of ischemia in relation to the occurrence of coronary events; b) examine the effects of all active ischemia out of hospital on prognosis; and c) to establish if monitoring of active ischemia provides incremental information about risk of coronary events a[art from usual testing. A prospective study n consecutive patients will characterize them according to history, symptoms, risk factors, exercise testing for myocardial ischemia and cardiac catheterization data. Serial 48-hour frequency modulated ambulatory monitoring of the electrocardiogram will be performed on and off standard medication at baseline and at 6 month intervals. The frequency and duration of all active ischemia out of the hospital will be related in a multivariate analysis to symptoms, clinical and laboratory data, and to the occurrence of coronary events such as death, myocardial infarction, hospitalization for unstable angina and the need for revascularization. The long-term aims of this project are to: a) test the importance of all ischemia out of hospital in apparently stable patients with coronary disease as a measure of risk for future coronary events that is more discriminating than conventional testing in hospital, and b) to provide an objective means for assessing the effects of new therapies. Out of hospital ambulatory monitoring has shown that asymptomatic ischemia is common and overlooked in the management of apparently stable patients with coronary disease. If the activity of ischemia affects prognosis, it may not be sufficient to treat symptoms alone and new goals may be necessary that aim to control all active ischemia during daily life.